ROC曲线评估hCG日P、E_2水平和E_2/P对IVF-ET结局的预测价值

Predictive values of serum progesterone,estradiol levels and estradiol / progesterone ratio on the day of hCG injection for the outcome of in vitro fertilization- embryo transfer evaluated by ROC

目的：探讨人绒毛膜促性腺激素（h CG）注射日血清孕酮（P）、雌二醇（E2）水平和E2/P对体外受精-胚胎移植（IVF-ET）临床结局的预测价值。方法：回顾性分析2008年1月-2012年9月在解放军105医院生殖中心接受IVF-ET治疗的不育患者共722个周期的临床资料,采用受试者工作特征曲线（ROC曲线）评估h CG日血清P、E2水平和E2/P对IVF-ET结局的预测价值,确定其临界值及最佳预测指标。结果：h CG日血清P水平和E2/P预测妊娠的曲线下面积（AUC）分别为0.72和0.64,均显著大于机会参考线下面积（P〈0.05）,对妊娠有预测价值,最佳临界值分别为2.01和1.13 ng/ml,敏感度分别为0.66和0.57,特异度分别为0.75和0.67,其中后者的AUC显著大于前者（P〈0.05）;血清E2的AUC为0.54±0.02,与机会参考线下面积比较差异无统计学意义（P〉0.05）。血清P、E2水平及E2/P预测流产的AUC分别为0.67、0.68、0.76,最佳临界值分别为1.59 ng/ml、3 022.42和2.02 pg/ml,均显著大于机会参考线下面积（P〈0.05）,对流产具有预测价值,其中E2/P对流产预测价值最高。结论：h CG注射日血清P水平对妊娠预测价值最高,E2/P对流产预测价值最高,两者可作为预测IVF-ET结局的参考指标。

Objective： To explore the predictive values of serum progesterone,estradiol levels and estradiol/progesterone ratio on the day of human chorionic gonadotrophin（ h CG） injection for the outcome of in vitro fertilization- embryo transfer（ IVF- ET）. Methods：The clinical data of infertile patients（ 722 cycles） receiving IVF- ET in this center from January 2008 to September 2012 were analyzed retrospectively,receiver operating characteristic curve（ ROC） was used to evaluate the predictive values of serum progesterone,estradiol levels and estradiol / progesterone ratio on the day of h CG injection for the outcome of IVF- ET,the critical value and the best predictive indexes were determined. Results： The areas under ROC（ AUC） of serum progesterone and estradiol / progesterone ratio on the day of h CG injection were 0. 72 and 0. 64,respectively,which were statistically significantly larger than the areas under the reference line（ P〈0. 05）; the optimal critical values were 2. 01 ng / ml and 1. 13 ng / ml,respectively; the sensitivities were 0. 66 and 0. 57,respectively; the specificities were0. 75 and 0. 67,respectively; AUC of the latter was statistically significantly higher than that of the former（ P〈0. 05）; AUC of serum estradiol was 0. 54 ± 0. 02,compared with the area under the reference line,there was no statistically significant difference（ P〈0. 05）. AUC of serum progesterone,estradiol levels and estradiol / progesterone ratio for predicting abortion were 0. 67,0. 68 and 0. 76,respectively,the optimal critical values were 1. 59 ng / ml,3 022. 42 pg / ml and 2. 02 pg / ml,which were statistically significantly higher than the areas under the reference line（ P〈0. 05）,the predictive value of estradiol / progesterone ratio for abortion was the highest. Conclusion： The predictive value of serum progesterone level on the day of h CG injection for pregnancy is the highest,the predictive value of estradiol / progesterone ratio on the day of h CG injection for abortion is the highest,both of them can be used as reference indexes for predicting IVF- ET outcome.